Is MARS system enough for A. phalloides-induced liver failure treatment?

Area of Science:

• Hepatology
• Toxicology
• Critical Care Medicine

Background:

• Amanita phalloides mushroom ingestion causes severe liver failure with high mortality.
• Optimal intensive care (OIC) alone has limited efficacy in these cases.
• Liver transplantation (LT) is often unavailable or not feasible.

Purpose of the Study:

• To evaluate the efficacy of Molecular Absorbents Recirculating System (MARS) compared to OIC for Amanita phalloides-induced liver failure.
• To identify prognostic markers for survival in patients treated with MARS.
• To assess the safety and depurative effect of MARS therapy.

Main Methods:

• A comparative study of six adult patients with Amanita phalloides-induced liver failure.
• Three patients received OIC, and three received MARS therapy (three 6-hour sessions).
• Laboratory parameters (ammonia, ALT, PT, bilirubin) and hepatic encephalopathy were assessed before and after MARS treatments.

Main Results:

• MARS therapy significantly decreased ammonia levels (p=0.011) and improved ALT and PT (p=0.004).
• Two patients experienced a bilirubin rebound (+116%; p=0.04) post-MARS.
• Mortality was 66.7% in the MARS group versus 0% in the OIC group; OIC survival rate was 0%.

Conclusions:

• MARS is an effective depurative therapy for Amanita phalloides-induced liver failure but requires adjunct treatments.
• Negative prognostic indicators include lack of PT/encephalopathy improvement, bilirubin rebound, and delayed MARS initiation.
• Survival is influenced by initial MARS response, mushroom quantity ingested, and time to treatment.